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PubMed1988

Recognition of dementia in general practice: comparison of general practitioners' opinions with assessments using the mini-mental state examination and the Blessed dementia rating scale.

In a study of 226 elderly residents in a retirement village in Sydney, Australia, general practitioners' opinions about dementia status had high positive and negative predictive values and high specificity, but low sensitivity when evaluated against the mini-mental state examination and the Blessed dementia rating scale. General practitioners were found to disagree with these two measures more often when patients were in advanced old age, and when they considered the patients to be depressed. We conclude that the general practitioner can increase his or her sensitivity to dementia in the elderly by use of either measure.

Aged↗
PubMed1983

Patient education in general practice: opinions of general practitioners.

Fifty-two general practitioners were interviewed regarding their task in patient education and various aspects of it. The view general practitioners have on patient education is complex. Although they consider it a central task, the range of methods they are willing to use is limited. Many general practitioners tend to overlook the fact that they are not the only source of information and explanation for patients. They would prefer to keep control over information given patients, fearing that patients might be confused. It is notable that many general practitioners have no clear standards of what patients need to know. Much depends on the questions the individual patient asks. There are several kinds of information that general practitioners are disinclined to give, particularly relating to uncertainties or information that might alarm the patient. The outlook for improvement must not be overestimated. Some directions are given for supporting the development of patient education.

Attitude of Health Personnel↗
PubMed1995

The concept of individualized hypertension care in general practice and outpatient clinics. The general practitioner hypertension practice study (III).

OBJECTIVE: To examine test ordering practice among general practitioners and hospital medical specialists according to the concept of individualized hypertension care. DESIGN: Mailed hypothetical case histories, with reference panels to categorize tests. SETTING: Uppsala-Orebro region in mid-Sweden. SUBJECTS: General practitioners (N = 90) and hospital medical specialists (N = 69) in randomly sampled primary health care centres and hospitals. MAIN OUTCOME MEASURES: Test ordering scores. RESULTS: 84% of invited GPs and 72% of specialists participated. According to reference panel standards, primary care physicians performed 75% of obligatory tests and specialists 88%. Superfluous tests constituted a larger proportion of the practice of hospital specialists (11-28%) than GPs (2-12%) in the six cases. Summarized examination scores revealed a wide practice variation within and between the two physician categories, specialists scoring significantly higher in three cases. Standardization of practice was more common among specialists, and differed significantly regarding serum potassium test, chest X-ray and ECG. Both groups deviated from current guidelines by omitting metabolic parameters. CONCLUSION: There is considerable practice variation in individualized hypertension care, which might influence treatment outcome. Practice audit and continuing medical education could contribute to care standardization according to guidelines.

Adult↗
PubMed1994

The prevalence of parkinsonism in Italy: an epidemiological survey of the disease in general practice. The Italian General Practitioner Study Group (IGPSG).

The prevalence and characteristics of parkinsonism have been assessed in two separate geographic areas in Italy (Arcisate and San Giovanni Rotondo). A total of 28,377 patients of 23 general practitioners (GPs) were the reference population. Fifty-eight patients were traced by the GP as having typical parkinsonian features or being treated with antiparkinson drugs. Among 53 subjects, 21 of them untreated, parkinsonism was subsequently confirmed neurologically. The overall crude prevalence rate was 1.87 cases per 1,000 (Arcisate 1.81; San Giovanni Rotondo 2.01). The age- and sex-adjusted prevalence rates were 1.84 in Arcisate and 2.04 in San Giovanni Rotondo. After exclusion of drug-related parkinsonism, the rates were 1.48 and 1.90, respectively. Even with some inconsistencies within the two study areas, the prevalence tended to be higher in San Giovanni Rotondo, to prevail in women, and to increase significantly with age. Presumed etiological factors for parkinsonism were recorded in 34% of the cases (mostly drugs). In two thirds of the cases the disease ran a mild course. The present study shows that the GP proves a valuable reference for surveys of parkinsonism in Italy.

Aged↗
PubMedDate not supplied

Patients with a psychiatric disorder in general practice: determinants of general practitioners' psychological diagnosis.

BACKGROUND: Although psychiatric disorders are highly prevalent in the community, many patients with a psychiatric morbidity remain unidentified as such in primary care. OBJECTIVE: The aim of this study was to analyze which clinical and sociodemographic characteristics of patients with psychiatric morbidity are related to general practitioners' (GPs) diagnosis of mental illness. METHODS: A 1-year naturalistic survey of primary care contacts of patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of affective disorder, anxiety disorder or alcohol abuse was carried out. RESULTS: Of the patients with a DSM-IV diagnosis, 10% did not visit their GP at all during 1 year, 40% visited their GP but were only diagnosed as having somatic diagnoses and 50% were given a psychological or social diagnosis at least once during 1 year. Affective disorders are more frequently diagnosed than anxiety disorders or alcohol abuse. The chances of psychological GP diagnosis increase with the number of GP contacts. CONCLUSIONS: GPs appear to have few indications to help them distinguish patients with a psychiatric morbidity from others, as long as the patients themselves do not express more explicit clues to their condition. Public mental health education and a better public relations policy are badly needed.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

Professionalism in general practice: development of an instrument to assess professional behaviour in general practitioner trainees.

INTRODUCTION: The aim of this study is to develop a new tool to assess professional behaviour in general practitioner (GP) trainees: the evaluation of professional behaviour in general practice (EPRO-GP) instrument. METHODS: Our study consisted of 4 phases: (1) development of a model of professionalism in general practice based on a literature review on professionalism, competency models of general practice and the overall educational objectives of postgraduate training for general practice; (2) development of the EPRO-GP instrument in collaboration with a sounding board; (3) establishing the content validity of the EPRO-GP instrument using a nominal group technique; and (4) establishing the feasibility of the EPRO-GP instrument in 12 general practice trainees and their general practice trainers. RESULTS: The model of professionalism in general practice encompassed 4 themes within professionalism: (a) professionalism towards the patient; (b) professionalism towards other professionals; (c) professionalism towards the public; and (d) professionalism towards oneself. These 4 themes covered 26 elements of professionalism. This model provided the framework of the EPRO-GP instrument, which we developed further by operationalising the 26 elements in 127 behavioural items. The expert ratings confirmed the content validity of the instrument with one exception: the element "altruism" was removed as a stand-alone category but it remained throughout the tool in items giving primacy to patient welfare. The results on the feasibility of the EPRO-GP instrument were very encouraging. All tutorials yielded professional behaviour learning points. DISCUSSION: Our results support the content validity of the EPRO-GP instrument as well as its feasibility as a tool to educate for professionalism in general practice.

Clinical Competence↗
PubMed1990

Computer application in a general practice.

Computer application in General Practice has improved the standard of healthcare. Computers have been used in the clinic for general administration and accounting. A Clinic Management System in addition can be used in most of the functions required in the running of a clinic. It will be able to generate useful data to help the doctors make sound decisions based on valid, up-to-date information. Communications and accessing of medical databases can be made available with a central network such as MediNet. There are currently no well developed medical record management systems suitable enough for implementation in general practice. Computerisation of the general practice will require careful planning and gradual implementation using a reliable application software backed by good support from the original developer. Commitment to continued research and development of the software will ensure that the implemented system will not be outdated.

Ambulatory Care Information Systems↗
PubMed2004

Management in general practice: the challenge of the new General Medical Services contract.

BACKGROUND: Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. AIM: To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. DESIGN OF STUDY: In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. SETTING: Three general practices in England, chosen using purposeful sampling. METHOD: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. RESULTS: Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. CONCLUSION: The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role.

Attitude of Health Personnel↗
PubMed1986

Use of antibiotics in general practice in Denmark. Prescribed daily dose, duration of treatment and number of treatments in general practice.

Prescribed daily dose (PDD) and duration of treatment is estimated for the most commonly used antibiotics in a multipractice study. In 1979 574 general practitioners and in 1983 625 general practitioners recorded 7 681 respectively 8 182 prescriptions of antibiotics over a five-day period. PDD and the number of treatments were compared with Defined Daily Dose (DDD) and DDD/1 000 inhabitants/day from the official statistics of drug consumption. It was found that these commonly used units were rather misleading with regard to the daily dose actually prescribed and the number of treatments given in a certain period.

Adolescent↗
PubMed2003

Psychosomatic symptoms among female unpromoted general practice dentists.

Unpromoted female general practice dentists have a working situation with hard work conditions. The aim of the present study was to describe the perceived health for unpromoted female general practice dentists in comparison with others having a somewhat similar working situation. Questionnaires were sent to all unpromoted female general practice dentists (n = 183) within the Public Dental Health Service in a region in Sweden. The response rate was 94%. Comparisons have been done with personnel in the Social Insurance Organization in Sweden and Children Clinics in the Public Health Care in a region in Sweden. The dentists in this study suffered from many physical and mental troubles and also linked them to the working situation. They reported high prevalences of tiredness (70%) and back, neck and shoulder pain (76%) and related these symptoms to the job situation in 83% and 95%, respectively. The study showed statistically significant differences (p < or = 0.0001) in the comparison between all the samples that were investigated. In conclusion, the results show problems concerning self-perceived health for the unpromoted female dentists. We have shown that they are feeling unhealthy, worse than other high-risk-groups in a human service working situation, and they suffer from a multitude of problems also connected to their working environment.

Career Mobility↗